Florida’s Marchman Act: Why Involuntary Commitment Works

Florida’s Marchman Act: Why Involuntary Commitment Works

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Florida’s Marchman Act is one of the most influential state laws that commit substance abusers to involuntary treatment. For over two decades, lawyers, judges, healthcare centers, and state officials have melded the Marchman Act with local and national policies. They have tinkered with its effects to improve addicts’ chances for recovery.

This is not to deny that Florida remains in a funding crisis. Its 67 counties do not always have enough money to pay for all the beds needed in treatment centers. Despite the state’s financial problems, the multiple and varied solutions that its cities and counties have developed serve as roadmaps for locales in 37 other states with involuntary civil commitment statutes.

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What is the Marchman Act?

The Marchman Act, passed in 1993, provides for the involuntary or voluntary assessment and stabilization of a person abusing drugs or alcohol. The person must have become impaired due to substance abuse, be a threat to themselves or others, and lack the ability to appreciate the need for assessment and stabilization. This means their life must be out of control: a job lost, an education abandoned, a child forgotten. In addition, the person with the addiction must not care.

Nancy Hamilton, CEO of Operation Par, a rehabilitation center based in Clearwater, said, “It’s harder to prove that an adult’s life is out of control and that they were a threat, as opposed to a juvenile.”

Anyone with personal knowledge of the person can bring a petition to have the person enter treatment. This includes the person’s spouse, guardian, relative, doctor, and even a law enforcement officer. The person filing the petition must have recently observed the behavior of the person who is the subject of the petition.

In a hearing, the person alleged of substance abuse is afforded an attorney to defend them in case they do not want to enter treatment. A hearing may be held in a courtroom or a treatment center or hospital. The judge or magistrate typically hears from the alleged substance abuser and that person’s doctors, spouse, parents, and attorney.

Starting a Conversation

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Judd Bean is a Tampa attorney who has represented both parents and alleged substance abusers in Marchman hearings. He said he is motivated to provide his services because he lost his sister to alcoholism. “I have empathy for both the alleged addict and their families. I’ve been in their shoes, at the worst levels. I know how they feel,” said Bean.

Bean said he does Marchman hearings primarily to give relatives and alleged substance abusers a voice. “A person is probably going to be much more successful (if they’re committed after a Marchman hearing) than if they just have their family tell them they have a problem,” said Bean.

Bean knows that everyone’s story is important. If an addict or parent’s story is not told well, he or she feels left out of the process. Bean’s job is to speak effectively for whichever party hires him so that the whole family becomes part of a shared dialogue. This helps all of the family members take each other more seriously and listen to one another.

“It’s nice to see the rekindling of these relationships between family members. Those kinds of things are priceless. That’s what makes it all worth it,” said Bean.

Andrew Washor, an attorney who does Marchman hearings in Broward County, agrees. He said another reason Marchman hearings work is because the people who control the hearings care about the people involved.

“The Marchman Act is not perfect. But you have people in the system: judges, clerks, and magistrates; who want to see people get better,” said Washor.

Providing Better Care

For years, Nancy Hamilton ran a juvenile addiction recovery facility. The lessons she learned from her patients have helped her keep Operation Par in its 45th year of business as a private treatment facility.

“All of our staff, even our janitorial staff, are trained in motivational techniques,” said Hamilton.“We have trained them to engage you, to get you to stay.”

Hamilton said when she encountered a juvenile who was so frustrated that he or she wanted to leave, she would ask them to stay just through supper.

“Sometimes, that day they hear another perspective on recovery. That day becomes a week, and that week becomes a month. Then people start to get the skills that they need to have a life of recovery,” said Hamilton.

Hamilton said she has seen repeat customers from Marchman Acts.

“We’ve had adolescents stay, go to college, and come back when they start using again. But they remember what they learned. The second time around was not just the same. They knew what they were doing and how well it was going to work out for them,” said Hamilton.

Hamilton said those who have come to her facility more than once work harder at recovery.

Melissa Larkin-Skinner, chief clinical officer at Manatee Glens, a treatment facility based in Bradenton, said most patients who are committed involuntarily start out more reluctantly on the path to recovery.

“It’s difficult, but our job is to try to show them why it’s best for them to get treatment,” said Larkin-Skinner.

Larkin-Skinner said she makes an effort to find inspirational speakers who give talks that help patients relate to staff and one another.

“We have people who periodically come back and talk about their success in rehab, whether it’s their first time or their tenth time. It’s really important for clients to hear their story,” said Larkin-Skinner. “Nobody wants to be addicted. The talks are one tool we use to try to help them see that there’s a way out. There is hope.”

Cutting Through Red Tape

Richard Brown, CEO of Agency for Community Treatment Services (ACTS), a treatment center based in Tampa, was part of the original works group to create the Marchman Act back in 1993. He said one of his biggest victories to get addicts help has come in the last three years, to improve care coordination.

“We’re co-locating in primary care sites, in the facilities where people get emergency medical care,” said Brown.

ACTS staff does rounds in hospitals alongside medical staff. They primarily come to the biggest hospital in the Tampa Bay area, Tampa General Hospital. This hospital serves many of the city’s poorest residents.

When Tampa Bay’s emergency rooms get filled up with addicts, ACTS staff are there to notice. They may suggest a doctor or law enforcement officer file a petition for assessment and stabilization. If an addict is ordered into involuntary treatment, ACTS staff is there to provide the person with transportation to its facility. In addition, ACTS staff is already familiar with the person. This eases the transition.

“Before we started this, there was no communication about people in need of treatment to the court. Folks were winding up in the ER and just staying around there. The volume the ERs had to deal with was incredible. The ERs were just filled up. Now, with us there on the ground, about 80% of what they were experiencing just went away,” said Brown.

Keeping Addicts Out of Jail

Marlene Minzey, Vice President of Special Services for First Step of Sarasota (FSOS), a treatment center based in that city, remembers when “pill mills” were in full swing.

“Communication has done a lot to bear down on the pain clinics,” said Minzey.

The trend lasted through the first decade of the new millennium. Patients saw multiple doctors to get more than one prescription of their drug of choice. They amassed large quantities of oxycodone and other strong narcotics. This facilitated theirs and others’ addictions, and caused the county’s number of arrests to skyrocket. At the time, the county was also seeing a high number of people being taken to jail for open container violations.

“There were so many people in jail for drugs; there was talk of opening a new jail,” said Minzey. “Finally, everybody in the community got together and said, ‘Let’s not take them to jail.”’

In 2003, after a number of discussions between different organizations in the community, Sarasota County funded an initiative to monitor how many intoxicated people went to jail. When the number was disclosed, the county decided that rather than build a new jail; it should help an existing treatment facility to become an Addictions Receiving Facility (ARF).

An ARF is a locked, secured facility that accepts substance-abusing offenders to be held involuntarily. FSOS received funds from the county. In August 2006, FSOS opened the doors to its then 30-bed ARF. Since that day, FSOS has saved approximately $350,000 for the county each year. The ARF has diverted hundreds of people from serving time in jail.

Minzey said having the conversations and working together as a community has been beneficial for Sarasota, especially people received at the ARF.

“They’re monitored by nursing staff 24/7, which allows us time to connect them with resources in the community. We bring AA, NA groups inside the unit every single day. Detox is a fairly quick process if they can just hang in there. People definitely stay voluntarily after their time is up,” said Minzey.

Minzey added that most people who stay a day or so at the ARF are happy to be there. After they are released, the county has developed a residential program at the Salvation Army. If the person sticks with that, he or she is eligible for transitional housing.

“We have a really high customer satisfaction rate: 90%,” said Minzey. “We give the same survey to everyone who leaves the units.”

Reaching Rural Areas

Richard Anderson, Senior Vice President of Meridian Behavioral Healthcare (MBH), a treatment center based in Gainesville, has been with his institution for 33 years. “I’ve seen some real success stories because of Marchman,” said Anderson. “Many times a Marchman Act is a motivator to get people into treatment.”

Anderson said MBH serves 10 counties, many of which are in rural areas. It also provides crisis services for two other counties.

In Alachua County and many surrounding areas, transportation is a barrier to treatment. Some individuals committed after Marchman hearings are delivered to MBH by law enforcement agencies. There are counties, which lack bus services. Other counties have towns that are small and set far apart. The geography and poverty in these areas prevents recovering addicts from easily reaching their counselors or support group meetings.

To alleviate these problems, MBH has developed housing programs for those who had received inpatient treatment to gain employment skills. Anderson said Meridian works hard to understand and prevent relapse.

“We don’t want to treat you and then leave you,” said Anderson. “We want to refer you to support groups, outpatient clinics, and housing and employment opportunities.”

Anderson said MBH is doing a good job with the funds it is given, but wants to become more of a one-stop center.

“We want to have medical staff, mental health staff, and substance abuse staff on board. That’s one of our goals. You want to make sure that you know the whole person. If you have all that in-house, you have a better idea of what is going on with the patient and how to provide treatment for them,” said Anderson.

Bigger Perspectives

Mark Fontaine is director of the Florida Alcohol and Drug Abuse Association (FADAA), a statewide organization that represents providers, coalitions, and treatment centers. He sees the Marchman Act as an excellent tool, but a law that could use a more solid source of funding.

“One of the problems we have with the Marchman Act is that we never built a system to fund it, like we did with the Baker Act. (The Baker Act is a mental health commitment statute.) Communities have to find their own resources to fund them [Marchman],” said Fontaine.

Fontaine believes frustration surrounding the Marchman Act could be eliminated through legislation that requires the state to more solidly fund treatment centers.

“There has not been a ‘Let’s Fund the Marchman Act’ initiative,” said Fontaine. He adds that this has invited insurers’ attempts to deny coverage to facilities for treatment.

The situation has improved in recent years. One reason is the passage of federal legislation, the Mental Health Parity and Addiction Equity Act, in 2008.

“The Parity Act basically said you have to cover diseases of addiction and mental illness. Since that passed, we find insurance companies are shifting to a better understanding that they have to cover addiction treatment,” said Fontaine.

Insurers also have gained a greater understanding of the impact of addiction on other chronic diseases.

“The patients are in treatment, and the treatment center is monitoring their blood pressure. The insurers realize that, and say, 'I’m getting some benefit from that.' However, we’re just getting there,” said Fontaine.

One of the biggest concerns was the state’s long-standing refusal of federal funds to expand Medicaid in Florida. For years, the denial of monies hampered Florida’s ability to better fund recovery treatment. Governor Rick Scott’s recent reversal on this decision might allow more dollars to be spent on addiction recovery.

Ute Gazioch is Director of Substance Abuse and Mental Health for the Florida Department of Children and Families (DCF). Through DCF, the state distributes state and federal monies to counties for Marchman beds.

Gazioch said that DCF currently has a taskforce now looking at the broader system of substance abuse and mental health care, “not just Marchman Acts and Baker Acts.”

She said that the Marchman Acts are key to recovery.

“The Marchman Act can be very effective to open that door to treatment,” said Gazioch.

Gazioch noted that one of the more positive trends in health care is that most providers in the state are now “co-occurring capable.” This means that an assessment of an individual will be comprehensive. “We make it a rule that providers can’t turn people away for substance abuse,”said Gazioch.“You have to treat the whole person.”

Gazioch said, however, that when it comes to recovery, there is no one way. Marchman Acts are only part of the solution.

“It provides an opportunity. You look for that opportunity. You look for enough time and sobriety during that time (the involuntary commitment), to help the person make that decision whether they want to go further with treatment. It doesn’t work all the time. But it can be very successful, for people who need that push. It’s a window,” said Gazioch.

Special thanks to the following for their interviews and assistance with this story: Evelyn Sapp, Elizabeth Hockensmith, John Foster, Alexis Lambert, Nick Van Der Linden, staff at the Florida Department of Health and the Florida Department of Children and Families, and all named sources.

Jessica Zimmer is an attorney who has worked as a news journalist for over 15 years. She has written for websites, newspapers, magazines, and companies. She has also worked as a copywriter and copy-editor for all sizes of businesses, both in the U.S. and abroad. Jessica writes about art, cannabis, education, engineering, law, music, politics, and transportation. Find her on Linkedin.

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